A study that simulated the effects of reduced barometic pressure (hypobaria) experienced by patients with traumatic brain injury (TBI) evacuated by air showed that prolonged hypobaria significantly worsened long-term cognitive and neurological outcomes. Maintaining normal oxygen levels did not affect the poorer outcomes after hypobaric exposure, and multiple exposures or use of 100% oxygen further worsened the effects in the rats studied, as described in an article published in Journal of Neurotrauma.

In “Simulated Aeromedical Evacuation Exacerbates Experimental Brain Injury”, Alan Faden, MD led a team of researchers from the Center for Shock, Trauma and Anesthesiology Research (STAR), University of Maryland School of Medicine, Baltimore, in designing a study that simulated the prolonged hypobaria that a soldier with TBI would experience if evacuated by air from the battlefield. The researchers examined the effects on learning, memory, movement, and depressive-like behaviors in rats with induced TBI exposed to 6 hours of hypobaria 24 hours after injury. Some rats were exposed to a second 10-hour hypobaric period 72 hours after injury.

Based on the results of this study, the authors suggest several approaches to limit the negative effects of hypobaric exposure following TBI, including delaying air transport, increasing cabin pressurization to reduce barometric effects, having specialized enclosures to individualize pressurization, or changing supplemental oxygenation protocols.

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